Since the fall of Roe v. Wade, Democratic lawmakers and reproductive rights advocates have maintained a clear strategy: Win a more progressive Democratic trifecta in 2024, eliminate the Senate filibuster, and pass comprehensive federal protections. When reporters asked about contingency plans — particularly given polls suggesting full Democratic control was unlikely — such questions were dismissed, cast as premature or defeatist.

Now, with Donald Trump’s return to power and Republicans set to control Congress, that strategy is drawing fresh questions. The GOP has signaled some openness to compromise: While campaigning, Trump said he supported abortion exceptions in cases of “rape, incest, and protecting the life of the mother,” and he promised to mandate insurance coverage for in vitro fertilization (IVF). Several Republican lawmakers have backed their own fertility treatment bills. Rep. Mike Lawler (R-NY) backed a Democratic-led IVF measure and speaks openly about his family’s consideration of the procedure. Sen. Joni Ernst (R-IA) has pushed legislation to expand over-the-counter contraception.

But reproductive rights organizations are doubtful. “We are not willing to compromise when it comes to our ability to make decisions about our bodies, lives and future,” Gretchen Borchelt, of the National Women’s Law Center (NWLC), said on a press call the day after the election. “What is the compromise that would provide relief for Amber Nicole Thurman’s family who’s grieving her every single day?” added NWLC’s president Fatima Goss Graves, referring to a patient who died from sepsis after being denied care.

Vox asked six major advocacy groups if they would consider pushing for new federal protections under a Republican-led Congress, be it for IVF, birth control or abortion. Most avoided giving a direct answer, instead directing the conversation to Republican accountability and the harm caused by abortion bans.

The stance reflects a deeper calculation: that accepting anything less than people deserve — meaning access to the full spectrum of reproductive health care for any reason — would legitimize restrictions and undermine the broader fight for bodily autonomy. When asked about pursuing partial protections versus holding out for more Democrats, groups choose waiting.

“We are really looking at this from a defensive position,” said Ryan Stitzlein, the vice president of political and government relations at Reproductive Freedom for All, the group formerly known as NARAL. “We read Project 2025, we are very familiar with the folks in leadership on the Republican side … and are preparing for them to levy attacks on reproductive freedom at all levels of government on the administrative side.”

Polling suggests there may be political opportunities

Despite the Biden era’s surprising bipartisan deals on thorny issues from gun control to climate change, there were never similar attempts to forge bipartisan compromise on reproductive rights. When a small group of Republican and Democratic senators introduced legislation in 2022 to codify elements of Roe, abortion rights groups quickly rejected the idea, arguing in part that it did not go far enough. Even on issues like IVF and birth control, where Republican support seemed possible and anti-abortion groups held less sway, there were no serious efforts to find common ground.

To be sure, while many Republicans have sought to reassure voters that they support IVF, their voting record thus far tells a different story. Many of those same lawmakers co-sponsored the Life at Conception Act, which could severely restrict fertility treatments by granting legal personhood from the moment of conception. Republicans have largely voted against Democratic IVF legislation, while claiming they’d support narrower fertility treatment bills and criticizing Democrats for not being open to working on amendments.

Still, polling suggests potential political opportunities. About 80 percent of voters say protecting contraception access is “deeply important” to them, and 72 percent of Republican voters had a favorable view of birth control. IVF is even more popular: 86 percent of Americans think it should be legal, including 78 percent of self-identified “pro-life advocates” and 83 percent of evangelical Christians. Americans’ support for abortion rights has intensified since the fall of Roe, and this reality shaped some Republicans’ rhetoric on the campaign trail. Newly elected Pennsylvania Republican Sen. Dave McCormick ran on a platform of fighting restrictions on fertility treatments and proposing a $15,000 tax credit for IVF.

Some policy strategists have suggested that, regardless of Republican sincerity, Democrats and abortion rights groups might benefit from pushing votes on new IVF and birth control bills, even if they offer limited protections or codify certain provisions that advocates oppose.

Such moves could either win new concrete protections or expose Republican resistance. But Democratic leadership and abortion rights groups for now seem uninterested in this approach, preferring to maintain pressure for comprehensively restoring rights.

“We haven’t seen a genuine effort from Republicans that they engage in this conversation,” Stitzlein said. “We’ve seen them propose bills to try to save face in response to Dobbs and the Alabama IVF ruling.”

Should Democrats keep their red line on abortion exceptions?

The political math around abortion exceptions would seem straightforward. Trump ostensibly supports them. Most Americans, including many Republicans, believe abortion should be legal in cases of rape, incest, and threats to the parent’s life. And women are being demonstrably harmed by the lack of workable exceptions in state bans today. One recent study estimated that more than 3 million women in the US will experience a pregnancy from rape in their lifetime.

Yet when asked whether they would consider seeking federal protections for abortion exceptions during Republican control as a harm reduction measure, established advocacy groups showed no interest, pointing to patients like Kate Cox and Amanda Zurawski who almost lost their lives or fertility despite state bans with exceptions.

“As we are seeing across the country, exceptions often don’t work in practice, so people should not take comfort in those or rely on them,” Rachana Desai Martin, chief government and external relations officer at the Center for Reproductive Rights, told Vox.

This position stems from a core belief: that any engagement with exceptions would validate the broader framework of restrictions. Some doctors on the ground in states with restrictive bans have bemoaned the lack of support they’ve received for carving out exceptions. “I worry that reproductive rights advocates may be digging into untenable positions and failing to listen to those affected most by the current reality,” wrote one maternal-fetal medicine physician in Tennessee.

On the question of codifying emergency medical protections, Planned Parenthood Action Fund stressed in an email that, “narrow health exceptions or those that focus only on emergencies are a disservice to patients and their health care providers because every pregnancy is unique.”

The position is particularly notable given these same groups’ strong defense of the Emergency Medical Treatment and Active Labor Act (EMTALA) at the Supreme Court this year. The groups argued that EMTALA — which requires hospitals to provide “stabilizing treatment,” including emergency abortion care — represents a crucial federal protection for women in medical crises. Yet when asked about codifying the Biden administration’s interpretation of EMTALA or similar protections through legislation, the groups demurred.

Internationally, exceptions have served as imperfect stepping stones to broader rights. Colombia’s journey from total ban to full decriminalization began with three abortion exceptions in 2006 — for health risks, fatal fetal conditions, and rape. Over 16 years, advocates used these flawed measures to help build public support and legal precedent for expanding access, ultimately leading to decriminalizing the procedure up to 24 weeks in 2022.

India and Spain followed similar trajectories. India’s 1971 Medical Termination of Pregnancy Act initially permitted abortion only for specific circumstances like health risks and rape. Advocates used this limited framework to gradually build broader rights — first emphasizing public health arguments around unsafe abortions, then expanding to gender equality concerns. This incremental approach led to significant expansions in 2021 and 2022, including extended gestational limits and broader access for unmarried women. Spain’s path from its restrictive 1985 law to its 2010 legalization up to 14 weeks followed a similar pattern, with advocates particularly leveraging Spain’s mental health exception to create de facto broad access.

These tensions — between principle and pragmatism, between long-term strategy and immediate needs — have taken on new urgency as patients in the US encounter the limitations of state-level abortion exceptions. In Louisiana, which has exceptions for protecting life, health, and fatal fetal conditions, almost no legal abortions have been reported since its ban took effect. Doctors say ambiguous laws and criminal penalties make them unwilling to test the rules.

But rather than pursue clearer federal standards around exceptions, advocacy groups are betting on abortion rights becoming more prominent as restrictions continue.

“Americans will continue waking up to stories of women who died preventable deaths because they were denied access to essential health care and voters will continue to see these bans wreak havoc on their families and communities,” declared a post-election strategy memo from Emily’s List, National Women’s Law Center Action Fund, Planned Parenthood Action Fund, and Reproductive Freedom for All. “With anti-abortion politicians in power, abortion rights will only grow in salience for voters in elections to come.”

Working with Republicans on even limited protections could also undercut the narrative of GOP extremism — a message advocacy groups see as crucial for winning in 2026 and 2028.

A high-stakes political bet

Despite abortion rights proving less galvanizing in the most recent election than Democrats had hoped, reproductive rights groups are betting that voter attitudes will shift as restrictions continue. Currently, 28 million women, plus more trans and nonbinary people of reproductive age, live in states with abortion bans.

“We have no interest in shrinking our vision,” Kimberly Inez McGuire, executive director of Unite for Reproductive & Gender Equity, said, “but the politicians who will soon govern a majority pro-abortion country would do well to expand theirs.”

In an interview with Vox, Democratic Sen. Tina Smith of Minnesota said she will work with anyone in Congress who wants to collaborate in good-faith to protect abortion rights, but stressed that as Democrats move into the minority, “the onus will be on Republicans” to come to the table and negotiate with them in a serious way. Asked about potential deal-breakers, Smith declined to discuss specific provisions in the abstract, saying she would wait to see complete proposals.

Smith’s view captured the movement’s current predicament: “We have been saying for several years after Dobbs that the way to protect people’s access to abortion is to win elections for people who are willing to protect those rights. And that didn’t happen, so there is no magic solution here.”